The TECNIS Symfony IOL (J&J Vision) is breakthrough technology that is providing remarkable outcomes and driving a huge increase in the uptake of presbyopia-correcting IOLs among cataract surgery patients, according to Elizabeth Yeu, MD.

“Before the Symfony IOL became available at the end of 2016, presbyopia-correcting IOLs accounted for only about 5% of my cataract surgery volume. The reason for this dismal rate is that although the previously existing technologies were wonderful for reducing dependence on glasses, they still had some significant limitations. The earlier presbyopia-correcting IOLs could give sweet spots of vision, with good performance at distance and either intermediate or near. And, with multifocal IOLs, optical performance is very sensitive to any macular pathology or ocular surface issues, which lead me to reserve them for the very healthiest of eyes,” said Dr. Yeu, Assistant Professor of Ophthalmology, Eastern Virginia Medical School, and a Corneal, Cataract, and Refractive Surgeon at Virginia Eye Consultants, Norfolk, Virginia.

“Now, however, considering the visual outcomes I have seen after analyzing my personal data for the Symfony IOL and Symfony toric IOL along with the level of my patients’ satisfaction, I am convinced that the Symfony IOLs are the best presbyopia-correcting IOL technology in the US market, and I recommend them with confidence. The extended depth of focus (EDOF) Symfony IOLs were designed to provide a continuous range of good quality vision, and that is what my patients are experiencing. Using these lenses, about 20% to 25% of all of my cataract patients are now getting a presbyopia-correcting IOL.”
Surpassing expectations

Dr. Yeu recently analyzed data for 192 eyes implanted with a Symfony or Symfony toric IOL. She noted that in general, her surgical plan is to target the dominant eye for plano and the nondominant eye for 0 D to -0.5 D.
In the subgroup of eyes implanted with the Symfony toric IOL, 90% had <0.5 D of residual astigmatism.
“Those are great results and assure me that the Symfony toric IOL is a wonderful opportunity for addressing significant astigmatism,” said Dr. Yeu.
Results from monocular VA testing showed that 97% of eyes achieved 20/25 at their preferred intermediate distance (between 50 to 60 cm) and 50% could see 20/16.

“With bilateral summation, we would expect that almost all patients were getting 20/20 uncorrected intermediate vision,” Dr. Yeu said.

“And the near vision results have been quite impressive as well, given the expected accommodative range of an EDOF IOL is about 1.50 D.”
With monocular testing, 87% of eyes read J3 or better at their preferred near distance and about one-third achieved J1. Dr. Yeu suggested that binocularly without correction, almost all patients would be able to read at least J3, and some J2.

“When we counsel patients about presbyopia-correcting IOLs, we present the Symfony IOL as an option that provides good uncorrected distance through intermediate vision, but that patients may need to wear glasses for reading. The cost for the Symfony IOLs is about $200 less than for an IOL package that we market for providing distance to near vision, but we tell patients that with the savings they will be able to buy a nice pair of reading glasses or bifocals,” said Dr. Yeu.

“This discussion sets proper expectations and underlies high patient satisfaction because for most patients, it under promises and over delivers.”

Patient counseling and selection

Dr. Yeu said that because she is so confident about getting good outcomes with the Symfony IOL, her pool of patients who can be offered a presbyopia-correcting IOL has grown.
“My objective checklist has gotten shorter. Patients still must have a relatively healthy eye, but I no longer exclude people with mild, stable macular pathology such as RPE mottling or dry eye, as long as it is responsive to therapy preoperatively,” she said.

The Symfony toric IOL also allows patients with significant astigmatism to be offered an IOL that will address both their presbyopia and astigmatism. When discussing options with patients who have significant astigmatism and interest in an advanced technology IOL, Dr. Yeu said she takes a top-down approach and recommends the Symfony toric IOL rather than a monofocal toric IOL.

“It makes clear sense to provide patients with the opportunity for both good quality distance vision and reduced dependence on glasses for near and intermediate distances. Therefore, the Symfony toric IOL has come to monopolize my toric IOL segment,” she said.

The Symfony IOL also meets patients’ needs for good intermediate vision. When talking about the relevance of this benefit, computer work is generally the first thing that comes to peoples’ minds. However, intermediate vision is involved in many other daily tasks, including checking a watch, reading a book, or looking at one’s self in the mirror, Dr. Yeu said.

“When I talk to my female patients, I say, ‘if you want to be able to see yourself in the mirror and be able to put on your mascara with some modicum of clarity, you need good uncorrected intermediate vision’. Women can strongly relate to that example, and it makes them think, I want that kind of vision after surgery.”
The potential for night vision symptoms is also part of the preoperative counseling discussion Dr. Yeu has about the Symfony IOLs. She said, “I explain that there is no free lunch. I say that the night vision symptom profile is different with the Symfony IOLs compared with multifocal IOLs. Just as the Symfony lenses “stretch” the focus to give a range of vision, they also stretch the beams coming out from point sources of light. As a result, patients may notice rays or rings, but I also say that the majority of my patients describe these phenomena as being mild or moderate and not distracting for driving.”

Compelling anecdotes

Dr. Yeu relayed the story of the sixth patient she implanted with a Symfony IOL, a 55-year-old woman who previously had successful cataract surgery in her fellow eye by another surgeon. The patient had a monfocal IOL in the first eye with a 20/20 UCVA outcome.

Dr. Yeu said she entered the examining room 1 day after implanting a Symfony IOL in the second eye to find the woman in tears. The woman explained she was crying because she was so overjoyed with the quality of her distance vision with the Symfony IOL.

“Her postop day 1 distance UCVA was 20/30, but the patient told me her vision was distinctly better in her Symfony eye than in her other eye, which had better acuity,” said Dr. Yeu.

“This case spoke volumes to me about the quality of the Symfony IOL optic and confirmed for me that its novel design, with reduced chromatic aberration and optimized negative spherical aberration, was successful for improving optical quality. I knew from this early case that the Symfony IOL was a great and unique lens.”

An experience involving a referring optometrist also offered a compelling testimonial to the outcomes that are achieved with the Symfony IOL, Dr. Yeu said.

“I would characterize this particular optometrist as being very demanding, and he was also very anti-presbyopia-correcting IOLs because he had referred patients to other practices who were unhappy after being implanted with a multifocal lens,” she explained.

“Recently, however, his mother needed cataract surgery, and he sent her to me to specifically requesting me to consider the Symfony lens for her having seen the very positive results of this IOL in other collaboratively managed patients.”

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This is so "spot on", exactly what I would write myself. My only concern is I can't provide this amazing lens to all my patients. I described it as the lens that causes the biggest smiles on day one that I have ever seen. The EDOF allows for a significant "fudge factor" so that an amazing percentage of patients will be 20/20 uncorrected. One pearl I have discovered is putting the patient in the phoropter and simply going one click of sphere at a time from plano to -1.50 and demonstrating that the focus is exactly as targeted. They can see 20/20 with every click in that interval. If they go from +.50 to -1.00 then they are under corrected by +0.50 but still thrilled.